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目的观察肠道内给予卡巴胆碱对兔肠部分缺血再灌注(I/R)损伤及重度烧伤患者肠道功能障碍的影响。方法将50只大白兔制成肠部分I/R损伤模型后,随机分为肠部分I/R损伤组(25只)、卡巴胆碱组[25只,于肠系膜上动脉(SMA)阻断后1h肠内注入3g/L卡巴胆碱(3μg/kg)]；另取25只设为假手术组,仅分离SMA,不阻断；取5只作为正常对照组,不致伤,处死后留取标本待测。检测兔SMA阻断前后及肠道内给予卡巴胆碱后肠黏膜的血流量。各致伤组均在处理后2、4、6、8、24、48、72h留取静脉血测定其血浆二胺氧化酶(DAO)活性及D-乳酸和D-木糖含量。并行葡聚糖蓝排出实验,以检测胃肠道吸收功能。同时选择大面积烧伤[烧伤总面积(84±12)%TBSA]患者8例,在患者肠呜音＜2次/min或腹胀明显时,口服1g/L卡巴胆碱(15μg/kg),观察给药后每分钟肠鸣音次数及腹胀情况。结果SMA阻断后肠部分I/R损伤组肠黏膜血流量为(48±6)PU,较正常对照组[(102±5)PU]明显减少,而肠道内注入卡巴胆碱后1h血流量增至(77±3)PU。肠缺血后肠部分I/R损伤组血浆DAO活性及D-乳酸含量开始升高,处理后24h达峰值[(4．63±0．27)U/ml、(7．9±2．4)mg/L],以后逐渐下降,但仍高于正常对照组[(0．89±0．14)U/ml、(2．0±1．1)mg/L,P＜0．05]。卡巴胆碱组的变化基本同肠部分I/R损伤组,但变化幅度较小；而假手术组则无明显变化(P＞0．05)。在给予D-木糖后2h,肠部分I/R损伤组血浆D-木糖含量显著降低,但处理后6h肠部分I/R损伤组及卡巴胆碱组明显升高,以后逐渐下降；假手术组略有波动。SMA处理后2h肠部分I/R损伤组葡聚糖蓝未见排出,处理后6h其运动距离逐渐增加,但处理后24h其运动距离仍明显短于正常值(P＜0．05),48～72h基本恢复正常；卡巴胆碱组注入葡聚糖蓝后即可见其排出,其运动距离明显增加,处理后6h达峰值(43±6)cm,以后逐渐缩短接近正常(28±3)cm。给药前患者肠呜音较弱(1．6±1．1)次/min,给药后10 min明显增强为(6．9±1．7)次/min,30 min时为(8．3±2．4)次/min,给药后1h患者肠鸣音仍较活跃,为(6．1±1．3)次/min。给药后2h患者腹胀明显减轻,其中有6例患者开始排便。结论肠内给予卡巴胆碱可增加兔肠黏膜血流量,改善其肠道运动、吸收、屏障功能；大面积烧伤患者口服卡巴胆碱,可改善其肠道功能障碍。
Objective To observe the effects of enteral administration of carbachol on intestinal ischemia-reperfusion (I / R) injury and intestinal dysfunction in severe burn patients. Methods Fifty rabbits were divided into intestinal I / R injury group (n = 25) and carba choline group (n = 25) after I / R injury model 1h intragastric administration of 3g / L carbachol (3μg / kg)]; the other 25 were set as sham operation group, only the separation of SMA, do not block; Take 5 as a normal control group, not injury, after the death Take samples to be tested. Blood flow was measured before and after rabbit SMA and intestinal mucosal administration of carbachol in the intestine. Venous blood was collected from rats in each injury group at 2, 4, 6, 8, 24, 48 and 72 h after treatment for determination of plasma diamine oxidase (DAO) activity and D-lactate and D-xylose content. Parallel dextran blue discharge test to detect gastrointestinal absorption. In the meantime, 8 patients with large area burn (84 ± 12% TBSA) were treated with 1 g / L carbachol (15 μg / kg) when the patients’ bowel sounds were less than 2 times / min or their abdominal distension was obvious. The number of bowel sounds and abdominal distension per minute after administration. Results The intestinal mucosal blood flow in the I / R injury group was (48 ± 6) PU, which was significantly lower than that in the control group [(102 ± 5) PU], but 1 h after intragastric administration of carbachol To (77 ± 3) PU. DAO activity and D-lactic acid content in the I / R injury group began to increase after gut ischemia, reaching a peak value of (4.63 ± 0.27) U / ml at 24h after treatment (7.9 ± 2.4 ) mg / L], then decreased gradually, but still higher than that of the normal control group [(0.89 ± 0.14) U / ml, (2.0 ± 1.1) mg / L, P <0.05] . The change in carbachol group was basically the same as that in intestinal I / R injury group, but the changes were insignificant, while there was no significant change in sham operation group (P> 0.05). At 2h after administration of D-xylose, the plasma D-xylose content in the intestinal I / R injury group was significantly decreased, but the intestinal I / R injury group and carbachol group were significantly increased 6h after treatment and then gradually decreased Surgical group slightly fluctuated. At 2 hours after SMA treatment, there was no exfoliation of glucan blue in the intestinal I / R injury group. The movement distance gradually increased 6 hours after treatment, but the movement distance was still significantly shorter than normal (P <0.05) 24 hours after treatment ~ 72h, and returned to normal after 72h treatment. Excretion of dextran blue was observed in the carbachol group, with a significant increase in movement distance (43 ± 6) cm at 6h after treatment, and then gradually shortened to near normal (28 ± 3) cm . The intestinal aphonia was weaker (1.6 ± 1.1) / min before administration and significantly increased to (6.9 ± 1.7) min / min at 10 min and (8. 3 ± 2.4) times / min. The bowel sounds were still more active at 1h after administration (6.1 ± 1.3) times / min. 2h after administration of patients with abdominal distension significantly reduced, of which 6 patients began defecation. Conclusions Administration of carbachol in enteral administration can increase intestinal mucosal blood flow and improve intestinal motility, absorption and barrier function. Carbachol can improve intestinal dysfunction in patients with extensive burn.